Gerard Breuker, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

70006130 Issued in IL

Practice address

535 E North St Ste C
Bradley, IL 60915-1188

Phone

(815) 802-7503

Fax

(815) 802-7514

NPI assigned

Mar 20, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

River Valley Physical Therapy Spine and Joint Center LLCGroup PAC ID 8426133950, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• River Valley Physical Therapy Spine and Joint Center LLC

  • Physical Therapist
  • Bradley, IL
  • NPI 1144401233

  IL, Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1992820807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 E NORTH ST STE C",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609151188",
            "telephone_number": "815-802-7503",
            "fax_number": "815-802-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 E NORTH ST STE C",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609151188",
            "telephone_number": "815-802-7503",
            "fax_number": "815-802-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREUKER",
        "first_name": "GERARD",
        "name_prefix": "Mr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "70006130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "070006130 1",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carl Edward Boyens, LCPC
• Sophia Boyer
• Bradley Bourbonnais School Distrist 307
• Bradley Royale, Inc.
• Bradley School District #61
• Kelly Marie Bufford, PT ATC
• Laura H Burkhalter
• Quincy Lee Campbell
• Denise Lynn Cannon, LMT
• Christine Cantrell

• All providers in Bradley, IL
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.